A case of aortic dissection caused by blunt chest trauma

A 74-year-old woman was struck by a car travelling at about 50 km/h. On arrival at hospital, a CT scan showed dissection of the ascending and descending aorta. She collapsed and died suddenly 8h later. At autopsy, there was massive bleeding into the left pleural cavity, ruptures of the pericardium and right ventricle, and a type A thoracic aortic dissection. The cause of death was haemorrhagic shock due to rupture of the pericardium and delayed rupture of the right ventricle following trauma to the chest. The thoracic aortic dissection was not the direct cause of death although histological examination did reveal that it occurred in the accident. Traumatic aortic dissection is rare although traumatic aortic rupture is a major cause of death after blunt chest trauma. This paper discusses the mechanisms, and factors involved in aortic dissection caused by blunt trauma.     

Polymorphism of eight X-chromosomal STRs in a Japanese population

Eight X-chromosomal short tandem repeat (X-STR) markers were analyzed in 258 unrelated Japanese (144 males and 114 females) using Mentype^® Argus X-8 PCR Amplification Kit (Biotype AG) which contains DXS7132, DXS7423, DXS8378, DXS10074, DXS10101, DXS10134, DXS10135 and HPRTB. The DXS10135 locus proved to be highly polymorphic marker (PIC: 0.945) and the DXS7423 showed the lowest value (PIC: 0.453). The exact test for genotype distribution showed no significant deviation from the Hardy-Weinberg equilibrium.     

A Fatal Case of Poisoning with Fentanyl Transdermal Patches in Japan

Fentanyl transdermal patches have been used to treat cancer‐ and noncancer‐related chronic pain. However, its inappropriate or illegal application may cause fatal poisoning. We herein present the case of a Japanese woman in her 40s who was found dead with seven 25‐μg/h fentanyl transdermal patches on her body. We established a detailed toxicological analysis procedure to quantify fentanyl, and its metabolite norfentanyl, and other drugs (acetaminophen, allylisopropylacetylurea, celecoxib, estazolam, promethazine, and sertraline) in human whole blood by ultra‐high‐performance liquid chromatography–tandem mass spectrometry. The measured fentanyl and norfentanyl concentrations in the femoral and cardiac blood were 0.051 and 0.072 μg/mL and 0.033 and 0.076 μg/mL, respectively. The decedent's fentanyl concentrations were consistent with previously reported postmortem blood levels for fatal cases of poisoning by fentanyl transdermal patches. Based on the decedent's case history, autopsy findings, and toxicological analyses, the cause of death was identified as intoxication with transdermal fentanyl.     

A case of death after ingestion of an agrochemical spreading agent

An agrochemical spreading agent was found near the slightly decomposed corpse of a deceased female. The appearance of the stomach contents suggested that ingestion of a surfactant had occurred before death. The spreading agent was found to contain nonionic nonylphenol ethoxylates (NPEO(n)) and anionic sulfonated naphthalene-formaldehyde condensates (SNFC(n)). A solid phase extraction cartridge containing a mixed reversed phase-weak anion exchange sorbent (Oasis WAX, Waters) was used to successfully extract both NPEO(n) and SNFC(n) from the blood. The cartridge was preconditioned with methanol and acetic acid (AcOH). After the dilute blood sample was applied to the cartridge, it was washed with AcOH, and then NPEO(n) and SNFC(n) were eluted with methanol/dichloromethane (7:3, v/v) and 5% NH(3)/80% methanol, respectively. The concentrations of NPEO(n=2-9) and SNFC(n=0) in the blood sample were 7.7μg/mL and 1.8mg/mL, respectively. It is possible that postmortem changes increased the concentration of SNFC(n=0) monomer by breaking down the polymer. However, the behavior of these compounds in the human body is unclear and further case studies are needed to investigate this result.     

Longitudinal brainstem laceration associated with complex basilar skull fractures due to a fall: an autopsy case

This report describes an autopsy case of a rare longitudinal brainstem laceration associated with complex basilar skull fractures. The victim was a 40-year-old male who died immediately after falling from a roof (9.2m in height) of a factory onto a concrete floor. The postmortem examination revealed an incomplete ring fracture of the base of the skull with longitudinal fractures of the sphenoid (clivus of the dorsum sellae turcicae) and occipital bones, cerebral contusions in the frontal and temporal poles, a longitudinal brainstem laceration at the posterior median sulcus of the pons accompanied with multiple contusional hemorrhages in the brainstem and corpus callosum. Related blunt-force injuries were observed in the parieto-occipital region of the head, shoulder and upper back involving the fractures of the cervical and thoracic vertebrae, and sternum and ribs, indicating a huge impact to the occiput and subsequent impression of the vertebral column into the base of the skull due to violent anteroflexion of the neck, which caused the complex basilar skull fractures, contusions and longitudinal laceration of the brainstem.     

Diatom numbers around the continental shelf break

Diatom concentrations in seawater were examined monthly at four aquatic areas. Diatom concentrations inside a bay showed a monthly variation, but these were detectable. On the other hand, in the open sea around the continental shelf break, there were few diatoms in any season. When a person drowns in the open sea, the diatom test cannot be expected to function reliably.     

Postmortem serum uric acid and creatinine levels in relation to the causes of death

Serum uric acid (UA) and creatinine (Cr) mainly derive from skeletal muscle tissues. Although, remarkable postmortem stability of the serum levels has been reported, there appears to be very poor knowledge of the diagnostic value in investigation of death, except for uremia. The aim of the present study was to evaluate postmortem serum UA and Cr levels using 395 forensic autopsy cases, in comparison with blood urea nitrogen (BUN), for investigation of the pathophysiology of death with special regard to the causes of death involving possible skeletal muscle damage, e.g. due to hypoxia, heat or agonal convulsions. Cr and BUN showed relatively good topographic stability in the cadaveric blood, whereas, UA was often much higher in the right heart blood than in the left heart and peripheral blood, independent of postmortem intervals. Moderate to marked elevation of Cr and BUN accompanied with hyperuricemia was observed in delayed death. In the acute death cases (survival time <30 min), UA, especially in the right heart blood, showed a considerable elevation in mechanical asphyxiation and drowning. The Cr level in fire victims with a lower carboxyhemoglobin (COHb) level (<60%) was significantly higher than in those with the possible fatal level (>60%). A similar elevation of Cr was observed in fatalities from heat stroke and methamphetamine (MA) poisoning. The observations suggested that hyperuricemia in acute death may be indicative of advanced hypoxia and that elevated Cr level may reflect the skeletal muscle damage, especially due to thermal influence.     

The oppression/emancipation nexus in ongoing power struggles: Village—Power dynamics in Western Nepal 1

Abstract

How can we gain a more nuanced understanding of power struggles than is assumed under the ‘power as domination’ perception that attributes power to dominant actors who exercise control over others, and thus dichotomises domination and emancipation? This article addresses this question by exploring the power dynamics underlying ‘participatory’ public works in a village in western Nepal. Drawing on an alternative analytical framework that brings together Giddens' ‘structuration’ perspective and the Foucauldian notion of power, the case study illustrates that dominance and resistance are interwoven in day-to-day social interactions, and that the existing social order is continually being readjusted. The article concludes by discussing this study's implications for proponents of empowerment, namely the need to ascertain the emancipatory potentials that are immanent in daily power contestation, and then to develop strategies that compensate for the limitations of everyday struggles.